Despite recent advances in the therapy of epilepsy, many patients, especially those with complex partial seizures are incapacitated by their disorder. We have been investigating improvement of seizure control and reduction of medication side effects through the application of newly developed intensive monitoring techniques including simultaneous video recording of seizures, long-term telemetering of EEGs and frequent determinations of antiepileptic drug concentrations. Patients with very long histories of uncontrolled seizures are admitted for a complete evaluation, including all basic neurologic studies and daily objective toxicity battery. Video recording and long-term telemetered EEGS establish a seizure diagnosis, a concept which has not been adequately emphasized in the management of patients with intractable seizure disorders. Efforts are then made, based on this seizure diagnosis, to "tailor make" a regimen which is appropriate for each patient. This includes use of newer antiepileptic medications which have decreased side effects in conjunction with blood concentrations which allow maximum therapeutic levels with minimal toxicity.